Most women will go into labour spontaneously by 42 weeks but sometimes help is needed. Medical induction, or bringing on labour, is increasingly common, about one in five labours are induced in the UK. If you have one, it will usually be planned in advance. You'll be able to discuss the advantages and disadvantages with your doctor and midwife, and find out exactly why they think it’s necessary. It is always your choice whether to have your labour induced or not.

Why might induction be recommended?

The most common reason for induction is that your health or that of your baby is at risk. This includes your pregnancy going on beyond 42 weeks, as after this time the placenta may become less efficient, increasing the risk of complications. Signs a baby is not growing well because of an ageing placenta is a reason for induction.

If you're more than 37 weeks pregnant, you may be offered an induction within 24 hours of your waters breaking to reduce the risk of womb infection.

Sometimes an induction is recommended if a mum has preeclampsia, high blood pressure, a high BMI, or gestational diabetes, though this is not the case for every mum with those characteristics.

There is a wide variety of other medical concerns and reasons induction may be recommended. They will always be explained to you and your consent is always required.

Can I ask to be induced any time after my baby is term?

You can certainly ask your healthcare provider. Your doctor or midwife will take your preferences into account and advise whether induction is the best decision for you based on your pregnancy and medical history, though it’s still likely they will recommend you stay pregnant as close to 40 weeks as possible for the sake of the baby’s health and development. Some women adore everything about being pregnant but others are keen to get it over with, and there is nothing wrong with wanting to meet your baby as soon as is safely possible. In general, however, and if your pregnancy is healthy, the safest way possible is to allow nature to take its course, where possible of course.

Be aware that induction isn’t suitable for everyone - there are pregnancies that are deemed too risky for one. If you have a low-lying placenta or have experience heavy bleeding in pregnancy,

Do I have to have a membrane sweep?

You’ll usually be offered a membrane sweep before an induction is recommended. As with your vaginal assessments, you can refuse this if you wish, but you may not be able to proceed with induction if you do. If you agree, you may not be kept in hospital after the sweep is done. You may be advised to take paracetamol beforehand and bring a maternity pad to wear on your way home. At your appointment, your midwife or doctor sweeps a finger around your cervix to try to separate it from the membranes of the amniotic sac surrounding your baby. This separation releases prostaglandins, which soften the cervix and may start your labour within the next 24-48 hours. Membrane sweeps can cause discomfort and bleeding. If you’ve been sent home after your sweep appointment, you should report any bleeding to your doctor. You can have mulitple sweeps, but repeated attempts fail you will usually be offered a medical induction.

How will my labour be induced medically?

Medical induction can happen in a number of ways. These include ripening your cervix, breaking your waters or an oxytocin drip that kick-starts your contractions. The artificial use of prostaglandins with pessaries or gels to make your cervix more labour-ready, whilst a balloon catheter can be used to help your cervix dilate, and having the doctor break your waters. The choice of method will be influenced by your medical history, as well as the reason for your induction, examination findings and its urgency. You should also check which methods are available in the unit where you plan to give birth if you want to be specific in your birth plan, as options can vary.

The Bishop score

A doctor will begin an induction by assessing your cervix’s readiness for labour through a system that rates it from one and ten. This is called the Bishop score, after the doctor that created the system, and it reflects how wide, thin and soft your cervix is, how low it is in your pelvis, and whether its opening is posterior or anterior. The cervical opening is in a posterior position through pregnancy to protect the baby, and typically moves forward to an anterior state when your baby is ready to be born.

If the Bishop score is high (6 or more), you’re considered ready for induction. The next step is to break your waters, after which, you may be given a drip with synthetic oxytocin to kickstart your contractions.

Ripening the cervix

If the Bishop’s score is low (6 or lower), more intervention is needed to get your cervix ready for induction. This intervention will be aimed at encouraging your body’s own prostaglandins or introducing artificial prostaglandins in order to increase blood flow to the cervix, making it softer and more “ripe” for labour.

To help ripen your cervix, you may be given a membrane sweep, as described above, or have a balloon catheter or synthetic prostaglandins applied internally. Your waters will only be broken when your cervix open enough to allow us to do so; some inductions can end at this point if this is not possible and we’ll discuss other options such as Caesarean section with you.

Breaking the waters

This is done through a vaginal examination and using a thin instrument to make a small hole in the sac that’s holding the baby in the waters.

After this, you will feel a gush of warm fluid which confirms your waters have been broken. Sometimes this might not happen and the doctor may need to repeat the process. We realise all of this sounds unpleasant and it is uncomfortable at times but it won’t harm your baby. Remember that induction of labour is never taken lightly and it won’t be recommended to you without solid evidence it’s best for you and your child. After your waters have been broken, you may be advised to put a maternity pad in your underwear, stay upright and move around as the baby can now move down and make more contact with the cervix, which can make it more favourable for labour.

Oxytocin drip

You’ll often be given a drip with synthetic oxytocin to kickstart your contractions.

Do any alternative or complementary ways to induce labour actually work?

Women have been trying to kick start labour since long before medical methods were developed, but how well do they work? Research into the efficacy of some alternative methods is limited. You may have heard about women who’ve been advised to eat spicy food. Some women swallow castor or evening primrose oil. None of these practices are based on solid evidence.

A review of the available evidence on acupuncture found it may help to ripen the cervix but it can also prolong labour. If you do feel strongly about having acupuncture, please ensure your practitioner has a pregnancy-specific qualification.

There is no research that shows aromatherapy, another alternative method, is an effective way to induce labour but there are concerns that exposure to the oils can cause excessive uterine contractions that result in reducing oxygen to the baby. Homeopathic remedies and reflexology can be very relaxing but there isn’t quality research that they help induce labour.

Sex is perhaps the most intriguing method of induction and we don’t want to dissuade you from trying it whenever you fancy, but there is no concrete evidence that it will work. In theory, the prostaglandins and oxytocin produced during a fun night in could make a cervix more favourable labour but we don’t know for sure. As you might imagine, it can be a hard thing to study. Relationships have ups and downs, especially when one partner is feeling worried and helpless while the other is pregnant.

Breast stimulation releases oxytocin and has been found to be effective in full-term pregnant women but it’s not an option that’s comfortable for everyone.

What does medically induced labour feel like?

It does feel different from spontaneous labour. Every woman’s experience is different, but the synthetic hormones you are given to get your contractions going don’t come with the same pain relief your body gives you with the natural stuff. Induced labour can be more painful. You may need an epidural and your hospital stay may also be longer than with spontaneous labour.

How long will induction take?

Things could take a while to get going even after induction, as long as a couple of days. Try to get some rest and use your time wisely. You could practice your perineal massage, harvest colostrum, bounce on a birthing ball, or just do things to protect your mental health and keep your spirits up, like watching a favourite television show or taking walks around the hospital. When labour starts you may be able to follow some of your birth plan even if induction was not a part of it, so make sure you reaffirm what you want or have your partner advocate for you.

Does induction always work?

No. It’s important to remember that it fails for a number of reasons. Two important examples are that you or your baby are simply not ready for labour yet.

Do I have to have a Caesarean section if induction fails?

You are more likely to have a Caesarean section recommended to you if your induction has failed but we’ll always talk you through what options are available to you and your consent will always be required. Please remember that the arrival of a child is never less magical because it happened through surgery after days of failed induction. Mum may be more tired but she is just as thrilled!

What do I need to know about being induced?